If you are applying by the OPM Form 1203-FX, leave this section blank.

7. Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

8. Other Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

9. Languages

If you are applying by the OPM Form 1203-FX, leave this section blank.

10. Lowest Grade

13

11. Miscellaneous Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

12. Special Knowledge

If you are applying by the OPM Form 1203-FX, leave this section blank.

13. Test Location

If you are applying by the OPM Form 1203-FX, leave this section blank.

14. Veteran Preference Claim

15. Dates of Active Duty - Military Service

16. Availability Date

17. Service Computation Date

18. Other Date Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

19. Job Preference

If you are applying by the OPM Form 1203-FX, leave this section blank.

20. Occupational Specialties

001 Psychologist

21. Geographic Availability

130970045 Carrollton, GA

22. Transition Assistance Plan

23. Job Related Experience

If you are applying by the OPM Form 1203-FX, leave this section blank.

24. Personal Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

25. Occupational/Assessment Questions:

Please choose the answers below that best describe your employment and experience. Note: "Target grade" is the highest grade included in this announcement. Current federal employees: to determine if you are on an Excepted Service appointment, look at block 34 of your latest SF-50.

1. If you are a permanent employee of the facility in which this vacancy is offered, choose one of the statements below. Otherwise, choose E.

A. I have not held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis. AND I am currently in a career or career/conditional appointment.B. I have not held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis. AND I am currently in an Excepted Service appointment.C. I hold the target grade, or a higher grade than the target grade, on a permanent basis.D. I held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis, but I am currently in a lower grade.E. I am not a permanent employee of the facility where this vacancy is offered.

2. If you are a permanent VA employee, choose one of the statements below. Otherwise, choose E. Note: If you are a facility employee, choose the same answer you gave to Question 1.

A. I have not held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis. AND I am currently in a career or career/conditional appointment.B. I have not held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis. AND I am currently in an Excepted Service appointment.C. I hold the target grade, or a higher grade than the target grade, on a permanent basis.D. I held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis, but I am currently in a lower grade.E. I am not a permanent VA employee.

3. If you currently are a permanent employee of another federal agency (NOT VA), choose one of the statements below. Otherwise, choose E..

A. I have not held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis. AND I am currently in a career or career/conditional appointment.B. I have not held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis. AND I am currently in an Excepted Service appointment.C. I hold the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis,.D. I held the target grade of this vacancy, or a grade higher than the target grade, on a permanent basis, but I am currently in a lower grade.E. I am not a permanent federal employee.

4. If you are a FORMER federal employee with reinstatement eligibility AND you are not a current federal employee, choose one of the statements below. To be eligible for reinstatement, you must have been served in a career appointment, or served in a career-conditional appointment within the past three years. The three-year limit does not apply if you have Veterans Preference.

A. I have not held the target grade of the vacancy, or a grade higher than the target grade, on a permanent basis.B. I have held a position at the target grade or higher, on a permanent basis.C. Neither A or B apply to me.

5. Are you a 30% OR MORE COMPENSABLY DISABLED VETERAN? To be eligible, you must have retired from active military service with a service-connected disability rating of 30% or more, OR have a rating by the Department of Veterans Affairs showing a compensable service-connected disability of 30% or more.

A. Yes.B. No.

6. Are you a VETERANS RECRUITMENT ACT (VRA) APPOINTMENT? (You can only choose this answer for vacancies announced at or below the GS-11 grade level or an equivalent grade.) To be eligible, you must have been separated under honorable conditions (this means an honorable or general discharge). Also, you must be: a disabled Veteran; OR a Veteran who served on active duty in the Armed Forces during a war, or in a campaign or expedition for which a campaign badge has been authorized (you must have received the campaign badge or medal); OR a Veteran who, while serving on active duty in the Armed Forces, participated in a United States military operation for which you received an Armed Forces Service Medal; OR a recently separated Veteran (separated within the past three years).

A. Yes.B. No.

7. Are you eligible for a VETERANS EMPLOYMENT OPPORTUNITY ACT (VEOA) APPOINTMENT? This means that you have Veteran Preference or you are a Veteran separated after substantially completing at least 3 years of continuous active duty service performed under honorable conditions (this means an honorable or general discharge).

A. Yes.B. No.

8. Are you eligible for some other NONCOMPETITIVE APPOINTMENT? This includes appointment based on an interchange agreement, severe disability, eligibility of some military spouses, or similar authorities. Please visit http://www.opm.gov/hr_practitioners/lawsregulations/appointingauthorities/index.asp to see information about interchange agreements and other noncompetitive appointments. MILITARY SPOUSES: please visit http://www.fedshirevets.gov/job/shams/index.aspx for more information about appointment eligibility.

A. Yes.B. No.

If you chose A, please tell us the type of appointment for which you are eligible (for example, military spouse eligible).

In accordance with 38 U.S.C. 7402(d), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. You must be proficient in basic written and spoken English in order to perform the duties of this position.

1. Are you proficient in basic written and spoken English?

A. YesB. No

The following questions pertain to your licensure and/or certification. Note: The Psychologist must hold a full, current, and unrestricted license to practice psychology at the doctoral level in a State, Territory, Commonwealth of the United States, or the District of Columbia

2. Are you licensed or certified by a state to practice psychology at the doctoral level?

A. YesB. No

Licensure requirement may be waived by the Secretary of the Department of Veterans Affairs for a period not to exceed two (2) years from the date of employment on the condition that the psychologist provide care only under the supervision of a licensed psychologist.

3. Are you a non-licensed psychologist and meet the eligibility requirements as stated above?

A. YesB. No

The following questions pertain to your degree in Psychology and psychology internship training program. You must have a doctoral degree in psychology from a graduate program in psychology accredited by the American Psychological Association (APA). AND have successfully completed a professional psychology internship training program that has been accredited by APA.

4. Do you have a doctoral degree in psychology from a graduate program in psychology accredited by the American Psychological Association?

A. YesB. No

5. Have you successfully completed a professional psychology internship training program that has been accredited by APA?

A. YesB. No

New Veterans Health Administration (VHA) psychology internship programs that are in the process of applying for APA accreditation are acceptable in fulfillment of the internship requirement, provided that such programs were sanctioned by the VHA Central Office Program Director for Psychology and the VHA Central Office of Academic Affiliations at the time that the individual was an intern and (2) VHA facilities who offered full on-year pre-doctoral internships prior to PL 96-151 (pre-1979) are considered to be acceptable in fulfillment of the internship requirements.

The following questions pertain to your experience. In additional to meeting the basic requirement, you must also have experience that was obtained through employment as a psychologist or through participating in a supervised post-doctoral psychology training program that demonstrates 1) active professional practice that was paid/non-paid employment and/or 2) a full, current and unrestricted license. To be creditable, the experience must have required the use of knowledge, skills, abilities and other characteristics associated with current psychology practice and must also have been at the level comparable to professional psychology experience at the next lower grade. This experience is only creditable if it is post-doctoral degree experience as a professional psychologist directly related to the duties performed.

6. Do you have two years of postdoctoral experience demonstrating possession comparable to professional psychology practice skills as described in the paragraph above?

A. YesB. No

In the space provided below, you must also include information to support your possession of each of the required professional knowledge, skills and abilities (KSA). This information will be used by the Professional Standards Board to determine your salary. The questionnaire will not allow you to skip any of the following KSAs. If these KSAs are fully addressed in your resume or vitae, please insert "See resume or vitae" in the space provided in order to proceed to the next item on the questionnaire.

KSAO #1: Knowledge of, and ability to apply, advanced professional psychological theories and techniques to the full range of patient populations.

KSAO #2: Ability to provide professional advice and consultation in areas related to professional psychology and behavioral health.

KSAO #3: Knowledge of clinical research literature.

Certification of Understanding - Select the appropriate answer to the statement below. Failure to provide an answer will result in your not being considered for this position.

7. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled; I may be denied an appointment; or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated and that responding "No" or providing no response to this item will result in my not being considered for this position.

A. Yes, I understand the information provided above and certify that the information provided in this questionnaire is true, correct, and provided in good faith.B. No, I do not certify this information and do not wish to be considered for this position.

REMINDER- you must provide a complete Application Package which includes: